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Erythema nodosum (EN) is a form of septal panniculitis that can occur secondary to multiple etiologies including inflammatory disorders, infections, or medications. We describe a 42-year-old woman who developed tender, erythematous, subcutaneous nodules persisting for 4 months following a copperhead snakebite. The diagnosis of EN was confirmed via histopathology, and the patient was treated with colchicine. Physicians should be aware of possible etiologies of EN to evaluate patients who present with new-onset tender subcutaneous nodules. Additionally, physicians should understand the various complications that can result from snakebites, with the potential for lingering cutaneous manifestations weeks to months following the initial bite.

A generalized fixed drug eruption (FDE) is an uncommon but potentially dangerous reaction to medication. In this case series, we present 1 patient with a generalized FDE and 2 patients with generalized bullous FDE that resolved with cyclosporine, though 1 patient required close monitoring in the intensive care unit. Immediate acceleration of care upon development and recognition of generalized bullous FDE is essential, as the mortality rate is similar to Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).

Sea urchin injuries are common following accidental contact with sharp sea urchin spines. Immediate manifestations of injury include local erythema, pain, and myalgia. Failure to remove the spines from the skin may result in delayed systemic reactions, secondary infection, granulomas, and-if joint spaces are involved-inflammatory or infectious synovitis and arthritis. The majority of severe complications can be avoided if the spines are fully removed from the skin soon after injury, which can be difficult. This article aims to bring awareness to the myriad complications from sea urchin injuries as well as the mechanisms for successful spine removal.

Patients presenting with a linear, erythematous, blistering eruption may experience a sudden painful sunburn that seems to get worse rather than better with time. In warm climates, exposure to the common fig tree (Ficus carica) may be the culprit. Dermatologists should recognize fig phytophotodermatitis as a possible cause and help the patient connect their symptoms with the inciting agent as well as administer proper treatment.

There is a large burden of treatable dermatologic conditions in refugee populations. Parasitic infestations are particularly common when there are barriers to basic hygiene, crowded living or travel conditions, and lack of access to health care. Body lice are associated with anemia and can transmit a variety of diseases; chronic impetigo secondary to scabies is a leading cause of chronic kidney disease globally. Dermatologists have unique skills to identify skin infections, inflammatory diseases, and infestations. Appropriate dermatologic care has the potential to improve overall outcomes.

Scorpionfish are among the most venomous creatures found in American and Caribbean seas. Their envenomation is responsible for considerable morbidity and socioeconomic burden associated with marine animal injuries. Avoiding physical contact with scorpionfish through proper identification prevails as the chief prevention method for stings. This article discusses common features of scorpionfish as well as the clinical presentation and treatment options following exposure to its toxins.

"Leaves of three, leave it be" serves as an apt caution for avoiding poison ivy (Toxicodendron species) and its dermatitis-inducing sap. Toxicodendron contact dermatitis (TCD) poses a notable burden to the American health care system by accounting for half a million reported cases of allergic contact dermatitis (ACD) annually. Identifying and avoiding physical contact with the western poison ivy (Toxicodendron rydbergii) plant prevails as the chief method of preventing TCD. This article discusses common features of T rydbergii as well as clinical manifestations and treatment options following exposure to this allergenic plant.

Rhipicephalus ticks are vectors of disease in humans and animals. Rhipicephalus sanguineus sensu lato (the brown dog tick) is one of the most geographically widespread tick species worldwide, likely due to its ability to colonize human and canine dwellings over a range of habitats. They transmit a variety of diseases to dogs and humans, including canine babesiosis, canine monocytic ehrlichiosis, hepatozoonosis, Mediterranean spotted fever, and Rocky Mountain spotted fever. Tick bites manifest as intensely pruritic, erythematous papules at the site of tick attachment; symptomatic relief usually can be achieved with topical antipruritics. Prevention of tick bites is best achieved through a combination of veterinary and environmental control; protective clothing; repellents, such as N,N-diethyl-meta-toluamide (DEET) and permethrin; and prompt identification and removal of ticks.

The sticktight flea (Echidnophaga gallinacea), a carrier of plague (Yersinia pestis), rickettsial infections, and other diseases, can be found in warm climates. The flea attaches to a host by embedding its head in the skin for days at a time. Most human infestations occur in individuals who handle infested animals. The sticktight flea can cause delayed erythema of the skin surrounding the embedded head. Common treatments include oral or topical antihistamines or a topical corticosteroid applied to the affected area.

Members of the Triatoma and Arilus genera (family Reduviidae) often are mistaken as the same arthropod, though their bites have vastly different health implications. Bites of the wheel bug (Arilus cristatus) are painful compared to Triatoma bites, which are painless but can cause disease and result in an anaphylactic reaction, posing a risk to human health because these pliable insects commonly infest residential dwellings. A common dermatologic presentation of bites from Triatoma species and A cristatus is an erythematous pruritic papule that can progress to an urticarial wheal, though the presentation can differ from patient to patient. Treatment depends on whether the reaction is localized or systemic, ranging from topicals to systemic agents if anaphylaxis occurs.

Capsicum peppers-including chili peppers, paprika, and red peppers-are native to the Americas but used worldwide in spicy dishes. Capsaicin, the active ingredient of Capsicum peppers, is used topically to treat musculoskeletal pain, neuropathy, and other conditions. Capsaicin binds the transient receptor potential vanilloid 1 (TRPV1), releasing substance P and desensitizing nerves with long-term use. Capsicum peppers and capsaicin products (eg, medications, cosmetics, pepper sprays) can provoke an irritant contact dermatitis, causing erythema and cutaneous burning. Capsaicin-induced dermatitis can be relieved by washing the area with soap, detergents, or oily compounds. Ice water or high-potency topical steroids also can help. Capsaicin is available in creams, lotions, and patches. Synthetic TRPV1-agonist injectables based on capsaicin are in clinical trials for use in localized pain. Capsaicin is a neuropeptide-active compound found in Capsicum peppers with many promising applications; however, dermatologists should be aware of possible skin reactions to these plants and medications derived from them.

Primula obconica, a household plant originally found in China that was introduced in Europe in the 1880s, has been reported to cause plant-induced contact dermatitis (CD). The condition more commonly is reported in Europe and less frequently in the United States, where the plant is not commonly included in patch testing protocols. Clinical features of P obconica CD can include facial and hand as well as fingertip dermatitis. The main allergens known to cause these findings are primin and miconidin. Treatment of P obconica CD mainly involves avoiding contact with the plant and applying a topical steroid.

Daffodils (Narcissus species) are the most common cause of irritant contact dermatitis among florists. Calcium oxalate crystals contained in the sap of the daffodil plants lead to irritant contact dermatitis on the skin. Daffodil rash commonly presents with fissuring, scaling, and erythema of the fingertips, hands, and forearms. The best preventative measure is to wear appropriate protective gloves and clothing.

Toxicodendron dermatitis is a type IV hypersensitivity reaction resulting from exposure to urushiol found in poison ivy, poison oak, and poison sumac. The dermatitis presents as a pruritic erythematous rash with vesicles and bullae in areas that were in contact with the plant. Symptoms present after 24 to 48 hours and can be managed with a variety of treatments, depending on severity. Avoidance is the principal way to prevent Toxicodendron dermatitis, highlighting the importance of educating patients on identification of plants.

Contact dermatitis is a common issue for many floral employees. Tulips are one of the most common causes of hand dermatitis. Tulipalin A is the main sensitizer in tulips and also is found in the Peruvian lily. "Tulip fingers" is the most typical clinical presentation of hand dermatitis from tulips and is characterized by erythematous scaling seen in periungual skin and between the first and second fingertips of the dominant hand. The best prevention for tulip contact dermatitis is to avoid exposure to the inciting plants or use nitrile gloves.

Ginkgo biloba is an ancient tree that originated in China and is now cultivated worldwide for its ornamental foliage and resistance to disease and pollution. Direct or indirect interaction with the ginkgo tree can cause allergic contact dermatitis, with erythematous papules, vesicles, and edema on exposed areas due to ginkgolic acids. On the other hand, ginkgo extract, produced from the tree leaves, has long been used in Chinese traditional medicine and is now a popularly consumed herbal medicine. Components of the ginkgo tree can cause dermatitis, but active ingredients in ginkgo extract may be beneficial; research on its safety and potential uses is ongoing.

Mosquito bites cause a variety of reactions ranging from pruritic papules to severe systemic hypersensitivity reactions. The salivary glands of mosquitoes have been found to contain more than 70 different allergens. Herein, we describe the pathophysiology and clinical appearance of mosquito bite reactions as well as proper management of this condition.

Jellies, more commonly known as jellyfish, are a common cause of stings in oceans throughout the world. Most stings result in immediate painful skin reactions that can be treated with hot water immersion and careful removal of adherent tentacles. Rarely, certain jellyfish species can cause life-threatening systemic reactions that must be treated promptly and monitored in the acute care setting. Wearing a full-body stinger suit or applying a sting-inhibiting lotion are common strategies that may reduce the risk for jellyfish injuries. Avoidance of waters during jellyfish season is prudent in regions that harbor more dangerous species of jellyfish, particularly along the Australian and Indo-Pacific coastlines.

Caterpillar envenomation is a worldwide problem, with manifestations ranging from dermatitis to iridocyclitis and a fatal hemorrhagic diathesis. This article focuses on the diagnosis and management of dermatoses related to caterpillars.

Bloodroot (Sanguinaria canadensis) is a plant that historically has been used in medicine for its antimicrobial, antihypertensive, anti-inflammatory, and antineoplastic properties. In dermatology, bloodroot has been utilized for its cytotoxic effects; it has been marketed as black salve as an anticancer treatment, but it does not come without notable toxicities. Unwanted cosmetic outcomes and even irreversible scarring and premalignant conditions have been reported. This article aims to bring awareness to both the therapeutic potential of S canadensis as well as the potential toxicities and risks associated with this North American plant.

Sea cucumbers are sausage-shaped aquatic creatures living on the ocean floors across the world. They are considered a food delicacy in many countries but also are known to have many beneficial pharmaceutical properties; however, sea cucumbers also contain a dangerous component called holothurin, which has been shown to have a negative impact on the health of both humans and other wildlife. In humans, exposure to holothurin can cause a painful irritant dermatitis, irritation of the mucous membranes, potential blindness, and, if ingested, even possible death. Treatment options include irrigation with seawater, soap, isopropyl alcohol, and vinegar.

Sponges from the phylum Porifera exist throughout the world in marine and freshwater environments. Although many encounters with humans are benign, some may lead to local dermatologic manifestations and in rare cases can cause more severe systemic reactions. Initial decontamination is of utmost importance to diminish the severity of the reaction. As contact between humans and coastal environments increases, it is important for physicians to know how to recognize and treat sponge dermatitis.

The human flea, Pulex irritans, is an important vector in the transmission of human diseases. This flea has been identified as a vector for the bubonic plague as far back as the 14th century, causing millions of deaths. Pulex irritans also has been identified as a vector for Bartonella bacteria species, which can cause trench fever. Rickettsia species, which can cause Rocky Mountain spotted fever and Mediterranean spotted fever, also have been identified in P irritans. Flea bites present as intensely pruritic papules and can be treated with topical antipruritics and corticosteroids. The most effective form of flea control and prevention includes a combination of insecticidal products and insect growth regulators.

The oriental rat flea (Xenopsylla cheopis) is an ectoparasite of small mammals and a vector of many diseases for which humans are incidental hosts. This species of flea is most widely known for carrying Yersinia pestis and Rickettsia typhi, the causative agents of the plague and murine typhus, respectively. Public health issues related to X cheopis may increase in the future as global warming expands the geographic area in which the fleas can survive. A bioterrorist attack of plague also remains a threat. Extensive research is ongoing regarding X cheopis and its interaction with the bacteria it transmits to find better ways of reducing related morbidity and mortality. Traditional control measures include extermination of small mammal hosts, insecticide use to eliminate the flea itself, and use of antibiotics to control the associated diseases. The future may include targeted insecticide usage to prevent the continued development of resistance as well as new methods of reducing transmission of flea-borne diseases that could eliminate the need for chemical insecticides all together.

Caterpillars-the larval form of butterflies and moths-belong to the order Lepidoptera. Some identified caterpillars from this order have developed venomous defense mechanisms such as irritating hairs and spines to protect themselves from predators. Direct contact to allergenic caterpillars' hairs can cause human disease. Cutaneous lesions following caterpillar envenomation can range from mild localized inflammatory signs and pain to a worsening appearance of vesicles, bullae, erosions, petechiae, necrosis, and ulceration. This review addresses the varied general manifestations caused by venomous lepidopteran exposure with special focus on the adverse cutaneous manifestations and therapeutic options of Megalopyge opercularis, the caterpillar of the flannel moth.

Centruroides is a common genus of bark scorpions in the United States with at least 21 species considered to be medically important, including the closely related Centruroides exilicauda and Centruroides sculpturatus. Stings from C exilicauda and C sculpturatus have been shown to cause fatality in children more often than in adults. More severe complications are caused by the neurotoxin released by Centruroides stings. Most stings can be managed at home, but for those patients who require treatment, antivenin has been shown to decrease time to symptom abatement.

Compared to head and pubic lice, body lice (Pediculus humanus corporis) carry increased morbidity in the form of greater body surface area involvement, possible infectious disease transmission, and the potential for secondary iron-deficiency anemia. They thrive in high-density urban populations in which hygiene is poor, such as among the homeless. Treatment includes washing of affected individuals, their possessions, and treatment with topical insecticides. Growing patterns of treatment resistance seen in body lice necessitate development of new strategies, with oral medications serving as a promising option.

The Hymenoptera order of insects includes Apidae (bees), Vespidae (wasps, yellow jackets, hornets), and Formicidae (fire ants). All 3 of these families of insects inject venom into their prey or as a defense mechanism via ovipositors in their abdomen. Three types of reactions can be seen after a vespid sting: uncomplicated local reactions, large local reactions, and systemic reactions (SRs). Although many vespid stings can be managed symptomatically, it is imperative for patients and providers to be aware of the possible severe reactions that can take place.

Blister beetles are a group of insects that include the Meloidae, Oedemeridae, and Staphylinidae families. The most well-known family, Meloidae, has more than 200 species known for causing a blistering dermatitis in humans by emitting the substance cantharidin, which has been pharmacologically used as a vesicant and can cause deleterious effects if ingested. Most recently, blister beetles have been studied for their anticancer properties.

We report a case of a 7-year-old Chinese boy who presented with acute fever, multiple oral ulcers, and skin nodules. A diagnosis of systemic Epstein-Barr virus (EBV)-positive T-cell lymphoma of childhood was established using systemic laboratory examination, imaging studies, bone marrow and skin biopsy with immunohistochemistry, and in situ hybridization for EBV-encoded RNA (EBER) and gene rearrangements. Notable features of this case include the absence of pancytopenia and hemophagocytic syndrome as well as spontaneous resolution without chemotherapy for several months; however, the condition relapsed, and the patient died.

Worldwide, there are more than 3250 deaths a year related to scorpion stings. With the increasing popularity of exotic and dangerous pets, American physicians are more likely to see exotic scorpion envenomations. Although adults are stung more often, children experience more severe envenomation.

Cat fleas (Ctenocephalides felis) often leave cats and dogs to bite humans, causing pruritic lesions of the lower extremities. Once flea bites are confirmed, various efforts can be made to eradicate these pests from the home or pets. Cat fleas also play a role in transmission of vector-borne diseases, especially endemic typhus.

Millipedes often are regarded as harmless but are capable of causing adverse reactions through the secretion of toxic chemicals. Millipede burns cause localized pigmentary changes that may be associated with pain or burning in some patients. Clinical suspicion and physical examination are paramount to the diagnosis of millipede burns.